Lack of support for treatment errors

Poor performance of many health insurance companies in the test of the consumer center NRW

11/10/2014

Medical errors often have serious consequences for those affected, and they often end up in litigation, where the question of possible claims for damages of patients has to be clarified. „After a treatment error, the health insurances must advise patients and assist the insured in asserting their claims for damages“, reports to the consumer center North Rhine-Westphalia. However, a recent survey of 50 statutory health insurances (72 were interviewed, 50 responded) revealed that support often fails to meet the needs of those affected.

A condition for the legally provided support of the persons concerned after a treatment error was, „that the error arose at a cash benefit and not yet barred“, so the message of the consumer center. Most of the time, the question of compensation for damages is the focus. Here, the health insurance companies can help with the medical assessment of the course of treatment and give a medical report to the Medical Service of the health insurance (MDK) in order, continues the Consumer Center. However, most advice seekers would not know at all that they can turn to their health insurance.

Only a few health insurance companies inform by direct cover letter
Although in the survey of the consumer center all health insurance companies to support the insured suspected of a treatment error. But only four percent inform their members directly with a cover letter, so the criticism of the consumer advocates. In this way, many victims remain unknown to the aid offer. 78 percent of the surveyed health insurance companies said that they informed the insured on their website about the possibilities, and 60 percent of the health insurance companies would publish contributions in their member magazine. However, this is not enough to reach all concerned.

Support at many health insurance rather low
The content of the health insurance companies sometimes also showed considerable deficits in terms of content, according to the criticism of the consumer advice center of North Rhine-Westphalia. Although the person affected by almost all insurance in principle „a general explanation about their rights, the support possibilities of the health insurance and the necessary steps in case of suspected treatment errors“ offered. In addition, according to the consumer advocates, however, only three quarters of health insurance companies „always do their own research by using in-house medical records (74 percent) and / or requesting them from doctors and hospitals (74 percent).“ Also, the MDK is only ever turned on by 70 percent of health insurances. The other insurance companies often refrain from using the MDK, „even if there are indications of a treatment error“, so the message of the consumer center.

Improvement of assistance required after a treatment error
Treatment errors can occur, for example, if a therapeutic intervention does not comply with the specialist medical standard. „But also lack of education or missing diagnostic steps can be a treatment error“, explains the Consumer Center. The amendment to the law from February 2013 was intended to significantly improve the difficult situation for those affected. However, this will not succeed with the current information policy of health insurance, so the charge of consumer advocates. In addition, it is important that „the health insurances assist the insured persons in their request for clarification of the facts until the suspicion has been eliminated or a report (by the MDK) has been drawn up“, reports the consumer center NRW. In addition, the health insurance companies should explain the results understandable to the person seeking advice, not only in writing, but also in a conversation, so the demand of the consumer advocates. So far, this is self-evident only for every third health insurance. (Fp)